Abstract

CELIS ZAPATA, J et al. Reconstruccion despues de pancreatoduodenectomia proximal mediante anastomosis pancreatoyeyunal simplificada. Resultados operatorios en 198 pacientes. Rev. gastroenterol. Perú [online]. 2006, vol.26, n.3, pp.271-277. ISSN 1022-5129.

INTRODUCTION: Pancreatojejunal anastomosis dehiscence is the most feared complication of proximal pancreatoduodenectomies and it is the cause of other complications, including death.  OBJECTIVE: We present our cumulative experience gathered with 198 proximal pancreatoduodenectomies reconstructed by using the simplified pancreatojejunal anastomosis technique.  OPERATION TECHNIQUE: It consists of performing a tobacco-pouch suture around the free edge of the jejunum in order to introduce 4 cm of the pancreatic stump guided by two transfixing sutures between the pancreas and the intestine, closing the jejunum over the pancreas tightening the tobacco-pouch suture and making four separate stitches to ìanchorî the anastomosis. The pancreatic and bile anastomoses are decompressed by jejunostomy.  MATERIAL AND METHOD: Prospective study in 198 consecutive patients who had proximal pancreatoduodenectomies at the Institute for Neoplastic Diseases during the 1995 - 2005 period.  RESULTS: Overall post-operative morbidity was 38.4% (76 out of 198 patients). Thirteen patients (6.6%) showed pancreatojejunal anastomosis dehiscence. Post-operative mortality after 30 days and hospital mortality were 2% and 3.5%, respectively.  CONCLUSIONS: Our modified pancreatojejunal anastomosis technique is simple, applicable to all types of pancreata and, most importantly, safe. It greatly reduces incidences of pancreatojejunal anastomosis dehiscence as well as post-operative morbidity and mortality.

Keywords : Pancreatoduodenectomy; pancreatojejunal anastomosis; anastomosis dehiscence.

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